Practice Profiles

How are health reform ventures being financed and what can be done differently?

In mid-2014, ReThink Health invited leaders of regional, multi-sector partnerships to share information on their efforts to promote health and resilience. More than 130 groups completed a brief profile, providing details on how they focus and finance their work. Topics included: their goals, achievements, and challenges; which financing mechanisms they had used;how their organizations and programs are structured; and how to they relate to external organizations that influence their thinking and actions. [See a summary of the findings.]

We inquired about their experience with 33 different financing mechanisms (grouped below in seven categories for display). Each financing tool had been used by at least one partnership. But most organizations relied on just a few—mostly foundation grants and government contracts.

Even though there is a large and growing menu of ways to channel resources into regional health reform, it is clear that most groups rely on short-term—often insecure—financing that is relatively labor-intensive to acquire. Additionally, most had used a total of three or fewer mechanisms, indicating a lack of diversity in funding sources for both their action agendas and infrastructure support.

That said, a larger proportion of groups with the most comprehensive action agendas (i.e., spanning healthcare access, quality, and/or cost; health behaviors and risk factors; social, economic, educational conditions or services; and physical environments) did say that sustainable financing is a top priority (38 of 43) compared to those with a more selective action agenda (45 of 83).

The next frontier for practitioners might be to develop greater fiscal fluency in areas that are less familiar, with a view toward better matching their broad aspirations with a wider mosaic of financing options. The next section provides a summary of several selected mechanisms that are rapidly evolving and worth exploring.